How Long Does Physician Credentialing Take?
The physician credentialing process typically takes 90 to 120 days (3–4 months) on average. However, the timeline may range from 60 to 180 days depending on organizational complexity, payer requirements, and regulatory compliance.
Credentialing Duration by Type:
Hospital Credentialing: 60–120 days
Insurance Credentialing: 90–120 days
Medicare Credentialing: 60–90 days
Medicaid Credentialing: 45–90 days
Physician Assistant Credentialing: A few weeks to several months (depending on background check and licensure requirements)
Why Does Physician Credentialing Take So Long?
Delays in medical credentialing occur due to multiple factors, including:
Incomplete or inaccurate applications → Missing details require back-and-forth corrections.
Manual primary source verification → Checking degrees, licenses, and work history directly with issuing bodies takes time.
Coordination between multiple organizations → Hospitals, payers, and regulatory boards must align.
Licensure delays → Slow state license processing impacts new providers entering networks.
How Do You Get Credential Verification?
Credential verification is a primary source verification process where submitted credentials are validated directly with original institutions.
Steps for Credential Verification:
Submit a verification request to medical schools, licensing boards, or employers.
Track status through credentialing portals or secure accounts provided by verification bodies.
Confirm credentials via QR code scanning (where available) or direct institutional contact.
How Long Should Physician Credentialing Files Be Kept?
Physician credentialing files must be securely retained while the provider holds privileges.
Post-employment retention: Files should be kept for at least the statute of limitations for malpractice (often 6 years or more).
Pediatric care exception: Retain until patients reach the age of majority.
Digital recordkeeping: Increasingly, healthcare organizations use indefinite electronic storage to meet compliance.
What Are the Steps in the Physician Credentialing Process?
The credentialing process follows a structured workflow:
Application submission → Education, training, licensure, employment history, malpractice insurance, and references.
Primary source verification → Confirm data with original institutions (medical schools, licensing boards, hospitals, employers).
Review of professional history → Clinical experience, malpractice or claims, disciplinary actions, peer recommendations.
Credentialing committee approval → Final vetting by hospital or payer credentialing body.
Enrollment in payer networks → Enables providers to bill insurers and receive reimbursement.
Recredentialing → Ongoing renewal every 2–3 years with updated documents.
How Does Physician Credentialing Work in Practice?
Physician credentialing is a comprehensive vetting system ensuring competency, compliance, and patient safety.
It involves:
Application collection
Primary source verification
Data validation and compliance checks
Committee approval
Payer enrollment
Ongoing recredentialing
How to Do Physician Credentialing Efficiently?
Physicians and credentialing specialists can streamline the process by:
Gathering required documentation: Diplomas, CV, licenses, malpractice coverage, references.
Submitting complete applications to credentialing organizations or payer networks.
Following up actively on verification requests to avoid unnecessary delays.
Maintaining compliance with continuing medical education and renewal requirements.
Summary of Credentialing Timelines
| Credentialing Type | Typical Duration |
|---|---|
| Physician Initial Credentialing | 90–120 days (3–4 months) |
| Hospital Credentialing | 60–120 days |
| Insurance Credentialing | 90–120 days |
| Medicare Credentialing | 60–90 days |
| Medicaid Credentialing | 45–90 days |
| Physician Assistant Credentialing | Weeks to several months |
FAQs
How long to get credentialed with medicare?
The Medicare credentialing process, also called enrollment, typically takes between 45 to 90 days, though it can take up to 120 days or longer depending on several factors.
How long does it take to get credentialed with medicaid?
The Medicaid credentialing process typically takes between 60 to 90 days on average, but it can take up to 120 days (4 months) depending on the state, completeness of the application, and response time to requests for additional information.
